Development of a Guideline for Infection Prevention and Control in Childcare Centers in Nigeria using the ADAPTE Process

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Childcare centers present high-risk environments for the transmission of infections due to poor hygiene practices, overcrowding, and lack of standardized infection prevention and control (IPC) guidelines. This study aimed to develop a contextually relevant IPC guideline for Nigerian childcare centers using the ADAPTE framework. Methods A methodological approach was adopted, employing the ADAPTE process, which consists of three phases: set-up, adaptation, and finalization. The PIPOH framework guided the formulation of health questions relevant to infection control in childcare settings. Eight international IPC guidelines were identified through systematic searches of academic and grey literature, out of which five were selected based on quality and applicability. The AGREE II instrument was used to appraise these guidelines. Stakeholders including public health professionals, paediatricians, education officers, and caregivers contributed to the external review of the adapted guideline. Results The adapted guideline addresses ten core IPC domains including hand hygiene, nasal hygiene, environmental cleaning, personal protective equipment use, food handling, waste management, immunization, and care of sick children. The final guideline was organized into four chapters and validated using the AGREE II tool. High domain scores (above 85%) were achieved in scope and purpose, stakeholder involvement, clarity, and applicability. The external reviewers confirmed the guideline's relevance and recommended it for implementation with minor modifications. Conclusion This study successfully adapted a practical, evidence-based IPC guideline suited to the Nigerian childcare context. The guideline has the potential to improve infection prevention practices, reduce childhood morbidity, and enhance caregiver competency. Future research should focus on implementation, training, and outcome evaluation across diverse Nigerian regions to ensure scalability and sustainability. Infection prevention Childcare centers Guideline adaptation ADAPTE process Nigeria Infection control Public health Figures Figure 1 Figure 2 Introduction Infectious diseases are a leading cause of morbidity and mortality among children under five, especially in low- and middle-income countries like Nigeria [ 1 ]. Childcare centers, vital for early development, often become hotspots for disease spread due to overcrowding, poor sanitation, and hygiene issues [ 2 ]. The rising demand for early childcare in Nigeria has led to many centers operating without standardized infection prevention and control (IPC) measures, increasing outbreak risks. Research shows that children in childcare are more vulnerable to infections—such as diarrheal and respiratory illnesses—than those cared for at home [ 3 – 5 ]. This problem is not only a Nigerian but a global public health concern. Despite expanding childcare services, Nigeria lacks IPC guidelines suited to these settings. Many centers operate without trained staff, proper hygiene protocols, or regulatory oversight, leading to higher infection rates and preventable child illnesses [ 6 ]. Evidence suggests that the absence of comprehensive IPC measures is associated with a higher disease burden among children in these environments [ 4 , 7 ]. Moreover, existing IPC guidelines, when available, are often too complicated, poorly enforced, or not adapted to local needs, resulting in low adherence and limited impact [ 8 ]. This situation worsens health risks, increases absenteeism, adds healthcare costs for families, and may cause long-term developmental issues in children. Developing practical, context-specific IPC guidelines is crucial to reducing these risks and improving health outcomes in Nigerian childcare settings [ 9 , 10 ]. The ADAPTE framework provides a systematic, participatory, and evidence-based method for customizing existing guidelines to local conditions [ 11 ]. It involves three phases—set-up, adaptation, and finalization—ensuring methodological rigor and cultural relevance while engaging stakeholders. This approach offers a practical way to adapt global best practices for the Nigerian context. This study describes the development of an IPC guideline for childcare centers in Ogun State, Nigeria, using the ADAPTE framework. The goal is to create an actionable, evidence-based, and locally relevant guideline that improves infection control, protects child health, and supports sustainable public health efforts in early childhood education settings. Methods and Materials This methodological study described the process of screening and adapting pre-existing guidelines for antipsychotic-induced hyperprolactinemia according to the ADAPTE process. The overall objective of adaptation is to take advantage of existing guidelines in order to enhance the efficient production and use of high-quality adapted guidelines. The adaptation process is meant to ensure that the final recommendations address specific health questions relevant to the context of use and address the needs, priorities, legislation, policies, and resources in the target setting, without undermining the validity of the resulting recommendations. [ 11 ] The ADAPTE process is illustrated in Fig. 1 . This study was conducted under the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Babcock University Health Research Ethics Committee (BUHREC), with reference number NHREC/24/01/2020. Approval was obtained from the Ogun State Ministry of Education, Science, and Technology, and the State Universal Basic Education Board. The requirement for informed consent was waived by the Babcock University Health Research Ethics Committee (BUHREC), as the study involved the analysis of publicly available or anonymized data. This waiver complies with national ethical regulations. Phases for adapting a guideline Three phases are needed to ensure guideline adaptation from one setting to another. The steps include the set-up phase, the adaptation phase, and the final phase. [ 11 ] Set-up Phase: activities in this phase include outlining the necessary tasks to be completed before beginning the adaptation process (e.g., identifying necessary skills and resources), with a first step of determining whether adaptation is feasible. It is expected that the guideline developer check whether adaptation is feasible, even if there are existing guidelines for a specific topic. [ 11 ] Adaptation Phase: This initial stage involves defining the topic, formulating relevant health questions, retrieving guidelines, evaluating evidence consistency and guideline quality, and preparing a draft adapted guideline. After identifying a broad topic, it’s important to clarify the purpose and scope by developing structured key questions. Clear health questions are vital for completing the adaptation process and ensuring the final guideline’s relevance in the new context. The framework considers key elements such as the target population, recommended actions, involved personnel, expected outcomes, and the delivery setting. It helps define health questions covering all relevant aspects: the population and disease characteristics, intervention(s), targeted professionals, anticipated outcomes, including patient and system results, and the healthcare setting for guideline implementation. Existing guidelines can assist in formulating health questions, and a quick review of their content may reveal additional questions. A search strategy should be developed based on the key questions to find guidelines and relevant documents, with inclusion and exclusion criteria set early based on factors like year, language, and developer group. Extensive searches are necessary to find suitable guidelines for adaptation, though sometimes prioritizing the adaptation of a specific guideline may be more effective than searching multiple sources. Screening retrieved guidelines aims to select those for further assessment, including a preliminary review of health questions to discard irrelevant guidelines. After screening, a draft adapted guideline is created, finalized once the developer determines the content and documents the process used. [ 11 ] Final Phase: this phase guides the user through the process of obtaining feedback on the document from stakeholders who will be impacted by the guideline, consulting with the source developers of guidelines used in the adaptation process, establishing a process for the review, and updating of the adapted guideline, and creating a final document. Furthermore, the following is expected to be done. [ 11 ] External review - Once the panel has decided to adapt the guideline, the next step is to send it to those affected by its implementation. This includes users such as practitioners, patients, policy makers, decision makers, organization representatives, and managers. Different questions may be posed to each group. The feedback should evaluate user acceptance, strengths, limitations, and areas needing refinement, as well as gauge confidence in the adaptation process and the likelihood of using the guideline. It should also consider the guideline's impact on current practices and resources. Additionally, endorsement bodies, such as professional or regulatory organizations closely linked to the guideline topic, should be approached to obtain formal approval to facilitate broad application. [ 11 ] Results Set-Up Phase The activities in this phase include outlining the necessary tasks to be completed prior to beginning the adaptation process (e.g., identifying necessary skills and resources), with a first step of determining whether adaptation is feasible. The guideline developers check whether the adaptation and select a specific topic. The title Infection Prevention and Control of Infection in Childcare Centers was selected as a topic. The main reason for the choice of this topic was a lack of guidelines to address infection prevention in Childcare centers and the increasing challenges of infection occurrence among children attending Childcare centers. The protocol for developing the guideline was understood. The resources and skills needed for the adaptation process were identified, which include guidelines to be adopted, research assistants, how to involve the stakeholders etc. Adaptation Phase This phase begins with topic selection and the identification of specific health questions. It involves searching for and retrieving guidelines, assessing the quality, consistency, currency, content, and applicability of the evidence, making decisions about adaptation, and preparing the draft of the adapted guideline. Scope and Purpose – Determining the health question using the PIPOH instrument. The researcher defined the PIPOH tool to help define the health questions. Population: are caregivers who take care of children in the childcare center, the caregiver must be above 18 years old, and could be male or female. The ownership of the Childcare Centers is not a barrier to the usage of the guideline, meaning the guideline applies to both public and private Childcare centers. Intervention: This is limited to the practice of the guideline to prevent infection among the children in the childcare center. Professionals: since the caregivers have the primary responsibility of caring for the children while in the Childcare centers, they become the professionals in this guideline. If the Childcare center is owned by a school, then teachers become the professionals, but if it is a standalone Childcare center, then the caregiver who is the service provider becomes the professional. Outcomes and outcome measures: Ideally, the guideline will encourage caregivers to understand they have a role to play in reducing the occurrence of infection in children. Likewise, it will help to promote the health of the children and at the same time reduce the morbidity rate among children, as this is an issue of public health importance. Healthcare setting and context: The guideline applies to childcare centers either in schools or within the community. With the use of the PIPOH, the following health questions were raised as stated on Table 1 Table 1 Health Questions What are infections, and the causes? How does infection spread? What are the roles of caregivers in hand hygiene for infection prevention? What are the roles of caregivers in nasal hygiene? How is personal protective equipment used in the Childcare centers? What are the steps to cleaning and disinfecting the environment of the childcare centers? How should food be handled by the caregiver? How should waste be managed in the Childcare centers? Immunization of the children and caregivers, how important is it? What should be done when a child is sick in the Childcare centers? Search for guidelines and other relevant documents Based on the key questions defined in the scope and purpose, a search strategy was developed internet search engines such as Google, Medline, ProQuest, were searched for the word ‘Guideline for infection prevention in Childcare center’, ‘Infection prevention for day-care,’ ‘Guideline for infection control in creche’, the search was limited to year 2000 to 2023. Guidelines were limited to those written in the English language. A single author guideline was not included in the search; below is the summary of the result. The guideline search found eight infection prevention guidelines for childcare centers from other countries (Table 2 ). Table 2 Search for guidelines and other relevant documents Title Publisher Country Publication date Management of Infectious diseases in Childcare Facilities and other Childcare settings Health Protection Surveillance center HSE 2007 Infection prevention and control in childcare settings Health Protection Scotland Scotland 2018 Infection Prevention guidelines for schools (primary) and childcare centers Ministry of health Singapore 2019 Infection prevention and control. Best practice advice for nurseries and childcare settings Public Health Agency Northern Ireland 2017 Preventing and managing illnesses in childcare centers Peel Public Health Ontario n.d Infection prevention and control in childcare centers Toronto public Health Toronto 2019 Standard and Universal Precautions in the Child Care Setting Childcare Health program California 2004 Infection control guidelines for early learning and childcare Healthy Child Manitoba Manitoba n.d Assessment of guideline quality Upon review of the eight guidelines, five were identified to be more detailed and useful for the adaptation process. The five selected guidelines were assessed for quality, currency, content, consistency, and acceptability/ applicability. [ 12 – 16 ] The evaluation of these different aspects provided the basis for making an informed and transparent decision about whether the source guidelines are related and for identifying which recommendations can be adapted into the current guideline. To assess the quality of the guidelines, the appraisal of guideline research and evaluation (AGREE II) instrument was used, which contains a 23-item tool comprising 6 quality domains. Domain 1. Scope and Purpose, Domain 2. Stakeholder, Domain 3. Rigour of Development, Domain 4. Clarity of Presentation, Domain 5. Applicability, Domain 6. Editorial Independence. Overall assessment includes the rating of the overall quality of the guideline and whether the guideline would be recommended for use in practice as shown in Fig. 2 . The appraisal gives an in-depth understanding of the content of each identified guideline, also gives a better awareness of the guidelines. Assessment of currency The publication dates of each of the identified guidelines were assessed. The five guidelines were identified to be up to date. Some of the guidelines were recently revised and other newly developed as dated on the Table 3 . Table 3 Currency of the Adapted Guidelines S/N Title Publisher Country Publication date G1 Infection prevention and control in childcare settings Health Protection Scotland Scotland 2018 G2 Infection Prevention guidelines for schools (primary) and childcare centers Ministry of health Singapore 2019 G3 Infection prevention and control. Best practice advice for nurseries and childcare settings Public Health Agency Northern Ireland 2017 G4 Preventing and managing illnesses in childcare centers Peel Public Health Ontario n.d G5 Infection prevention and control in childcare centers Toronto public Health Toronto 2019 Assessment for acceptability and applicability The acceptability and applicability of a guideline's recommendations for a new guideline depend on the degree to which a guideline will need adaptation based on the cultural and organizational diversity. It was discovered that the listed guidelines described the population eligible to use the guideline. The interventions listed in the guidelines met the current situation and are applicable, although some contents are not applicable in the cultural setting of Nigeria as shown in Table 4 . The guidelines were able to answer the health questions stated in Table 1 . Table 4 Illustrating the Applicability of the Guidelines. Health Questions G1 G2 G3 G4 G5 What are infections, and the causes? ✓ X ✓ X X How does infection spread? ✓ ✓ ✓ X X What are the roles of caregivers in hand hygiene for infection prevention? ✓ ✓ ✓ ✓ ✓ What are the roles of caregivers in nasal hygiene? ✓ ✓ ✓ ✓ ✓ How is personal protective equipment used in the Childcare centers? ✓ ✓ ✓ X X What are the steps to cleaning and disinfecting the environment of the childcare centers? ✓ ✓ ✓ ✓ ✓ How should food be handled by the caregiver? X ✓ ✓ ✓ ✓ How should waste be managed in the Childcare centers? ✓ ✓ ✓ ✓ Immunization of the children and caregivers, how important is it? ✓ ✓ ✓ X X What should be done when a child is sick in the Childcare centers? X ✓ ✓ X ✓ What are infections, and the causes? X X X X ✓ How does infection spread? X X ✓ ✓ ✓ Key: G1 = Guideline on infection prevention and control in childcare settings (Scotland) G2 = Infection prevention guidelines for schools (primary) and childcare centers (Singapore) G3 = Guideline on infection prevention and control. Best practice advice for nurseries and childcare settings (Northern Ireland) G4 = Guideline on Preventing and managing illnesses in childcare centers ( Ontario) G5 = Guideline on infection and control in childcare centers (Toronto) Preparation of the draft adapted guideline The guideline was developed based on the health questions raised. The drafted guideline was sectioned into four chapters. The five identified guidelines were used to develop the guideline, which covered all aspects of the health questions raised. The cultural applicability of the guideline was considered bearing in mind that none of the identified guidelines originated in Africa country. Final Phase The final phase guides through the process of obtaining feedback on the document from stakeholders impacted by the guideline. This process is called the external review. The draft guideline for infection prevention and control in the childcare center was sent to experts in the field of infection prevention, paediatricians, and teachers. The external reviews were asked to provide their input on the guideline. The external reviewers made a few comments. The final version of the adapted guideline was formatted to take into consideration the external reviewers’ comments (Supplementary material). Validation of The Guideline Using Appraisal of Guidelines for Research & Evaluation II Instrument The appraisal of guidelines for research & evaluation II (AGREE II) tool is designed not only to give individual scores to each of the 23 statements, (17) but also to provide an overall domain score for each of the six domains that averages all of the appraiser responses. The guideline was validated by four experts, two in the education sector (the representative of the Ministry of Education, Science and Technology and Ogun State Universal Basic Education Board) and two experts in the health sector (Public Health Nurse and Paediatrician). The evaluation was done using the AGREE II Instrument. To assess guideline quality, the AGREE II framework offers structured criteria across multiple evaluation domains. of the practice guideline and consists of 23 items organized into six domains. Domain 1 addressed the scope and purpose of the guideline through three key questions that concentrated on the aim, health questions, and target population. All appraisers scored each item within this domain at an average score of 94%. Domain 2 assessed the stakeholders’ involvement through three questions that focused on guideline development. The average score for this domain was 94%. Domain 3 addressed the rigor and development of the guideline; this section contained eight items and focused on the method of gathering and analysing evidence. The appraisers’ average score for this domain was 85%. Domain 4 included three key items that evaluated clarity and presentation of the All appraisers scored this section with an average score of 95%. Domain 5 addressed the applicability of the guideline through four questions. One of the questions in this domain, Item 21 (the guideline present monitoring and/or auditing criteria) did not apply, and adjustments were made to the adjusted score for Domain 5 was 93%. The item with the lowest scores in this domain was Item 18, which addressed the guideline description of facilitators and barriers. Domain 6 validated two items for the editorial independence, the combined score for Domain 6 reported score was 90%. The last two items in the AGREE II instrument were included in the section titled “overall guideline assessment”. The first item in this section required appraisers to rate the overall quality of the guideline, and the combined score for this section was 88%. The second item required participants to respond to the statement, “I would recommend this guideline for use.” The responses included yes, yes with medication, or no. Two of the appraisers reported yes for this section, and two reported yes with modifications. Discussion The development of an infection prevention and control (IPC) guideline for childcare centers in Nigeria using the ADAPTE framework highlights a strategic effort to close a critical public health gap. In Nigeria and other low-resource settings, children in institutional care environments face elevated risks of infectious diseases due to poor hygiene, limited caregiver training, and inadequate infrastructure. [ 18 – 20 ] These vulnerabilities are exacerbated by the absence of standardized, context-specific IPC protocols, underscoring the need for a structured and locally adapted guideline. This study demonstrated the utility of the ADAPTE methodology in translating global best practices into practical and culturally aligned solutions. The process enabled the selection, critical appraisal, and contextual modification of five internationally developed IPC guidelines. According to recent literature, adapting existing guidelines, rather than creating new ones from scratch, enhances cost-effectiveness, shortens development timelines, and improves the contextual relevance of interventions. [ 21 , 22 ] By using the PIPOH framework, the health questions formulated addressed core concerns such as hand hygiene, personal protective equipment use, environmental disinfection, food handling, and the management of ill children—all areas closely linked to infection transmission in childcare settings. These align with the growing global emphasis on environmental and behavioural components of IPC, particularly in congregate childcare environments. [ 23 , 24 ] Stakeholder engagement, through external reviews by health and education professionals, was a cornerstone of the adaptation process. Their input strengthened the guideline's relevance, usability, and acceptability. Recent implementation research emphasizes that the involvement of end-users during the design phase of health guidelines is a predictor of successful adoption and sustained use. [ 25 , 26 ] The AGREE II validation scores further affirm the quality of the adapted guideline. High ratings in domains such as “scope and purpose,” “stakeholder involvement,” and “clarity of presentation” mirror findings from recent studies on best practices in guideline adaptation. [ 27 , 28 ] This reflects not only the methodological robustness of the guideline but also its potential to influence caregiver behaviour and policy formulation in Nigeria. However, as with most guideline development projects, implementation remains a potential challenge. Evidence from similar LMIC contexts shows that without ongoing training, supervision, and institutional support, the translation of guidelines into practice is often limited. [ 26 , 29 ] Thus, to ensure sustainability, this guideline must be integrated into existing health and education frameworks and supported by capacity-building programs for caregivers. In summary, the adaptation of IPC guidelines for childcare centers using the ADAPTE process provides a replicable model for other low-resource settings facing similar challenges. The project fills a critical gap in Nigeria’s childcare health landscape and represents a meaningful step toward reducing infection rates and promoting child health through locally appropriate, evidence-based interventions. Conclusion This study successfully developed a context-specific guideline for infection prevention and control (IPC) in Nigerian childcare centers using the ADAPTE framework. By systematically adapting high-quality international guidelines and tailoring them to the local cultural, infrastructural, and regulatory realities, the resulting guideline offers a practical tool for reducing the burden of infectious diseases among children in early childcare settings. The involvement of key stakeholders and the use of a validated appraisal tool (AGREE II) ensured methodological rigor, stakeholder relevance, and clarity of presentation. The guideline addresses critical areas of IPC, including hand hygiene, environmental cleaning, food safety, waste management, and the management of sick children, thereby equipping caregivers with actionable steps to prevent disease transmission. Its development represents a significant step toward strengthening childcare health systems in Nigeria and contributes to the global agenda of reducing under-five morbidity from preventable infections. However, the absence of a pilot implementation phase highlights the need for future research to evaluate the guideline’s real-world effectiveness and scalability. To ensure sustainable impact, efforts must focus on integrating the guideline into existing health and education policies, providing caregiver training, and securing institutional support. In conclusion, this adapted IPC guideline is a critical and timely response to the infection control challenges in Nigerian childcare centers. If effectively implemented, it holds the potential to improve child health outcomes, enhance caregiver practices, and support broader public health objectives in Nigeria and similar low-resource settings. Strengths of the Study The study applied the internationally recognized ADAPTE framework, ensuring a structured, evidence-informed, and transparent adaptation of global IPC guidelines to the Nigerian context. This enhances the credibility and methodological rigor of the guideline development. The adapted guideline addresses specific local needs by incorporating Nigeria-specific cultural, infrastructural, and policy-related realities, increasing its feasibility and applicability in childcare settings. Input from both healthcare and education sector experts, including public health professionals, paediatricians, and education administrators, ensured a broad-based consensus and relevance across disciplines. The quality of the adapted guideline was thoroughly evaluated using the AGREE II instrument, providing a robust assessment of its scope, rigor, clarity, and stakeholder involvement. Limitations of the Study Lack of African-Origin Guidelines for Benchmarking; all source guidelines used for adaptation were from non-African, high-income countries, which may limit the relevance of certain content despite contextual modifications. Although the guideline is tailored to low-resource settings, its successful implementation may still face challenges such as inadequate training, limited funding, and insufficient monitoring infrastructure in many Nigerian childcare centers. Abbreviations CCs Childcare Centers IPC Infection Prevention and Control ADAPTE Adaptation (a systematic framework for guideline adaptation, from the ADAPTE Collaboration) PIPOH Population, Intervention, Professionals, Outcome, Health system AGREE II Appraisal of Guidelines for Research and Evaluation II WHO World Health Organization BUHREC Babcock University Health Research Ethics Committee G1 Guideline on infection prevention and control in childcare settings (Scotland) G2 Infection prevention guidelines for schools (primary) and childcare centers (Singapore) G3 Guideline on infection prevention and control: Best practice advice for nurseries and childcare settings (Northern Ireland) G4 Guideline on Preventing and managing illnesses in childcare centers (Ontario) G5 Guideline on infection and control in childcare centers (Toronto) LMIC Low- and Middle-Income Countries COVID-19 Coronavirus Disease 2019 PMCID PubMed Central Identifier (used in citations, e.g., PMC articles) Declarations Ethics approval and consent to participate: Babcock University Health Research Ethics Committee (BUHREC) with approval number NHREC/24/01/2020 Clinical Trial: Not applicable Consent for publication: Not applicable Availability of data and material: All data and materials in this article are included in the manuscript. Competing interests : None Funding: The author did not received any funding Author’s contributions – OE: Conceptualization, data collection and analysis, manuscript draft and final manuscript. Appreciation The author appreciates the Babcock University Health Research Ethics Committee (BUHREC) for providing ethical approval and guidance, as well as to the Ogun State Ministry of Education, Science and Technology, and the Ogun State Universal Basic Education Board for granting institutional support and access to key stakeholders. Likewise, all the external reviewers—including public health professionals, paediatricians, education officers, and caregivers—who generously contributed their expertise and constructive feedback during the adaptation of the guideline. Lastly, the author appreciates all research assistants, collaborators, and caregivers in the participating childcare centers, whose cooperation and participation made this work possible. References WHO. Infection prevention and control in the context of coronavirus disease (‎COVID-19)‎: a living guideline [Internet]. Health Topics. 2023 [cited 2025 May 28]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-guideline-2023.2 Azor-Martinez E, Garcia-Fernandez L, Strizzi JM, Cantarero-Vallejo MD, Jimenez-Lorente CP, Balaguer-Martinez JV, et al. Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial. Am J Infect Control. 2020 Nov 1;48(11):1315–21. Azor-Martinez E, Yui-Hifume R, Muñoz-Vico FJ, Jimenez-Noguera E, Strizzi JM, Martinez-Martinez I, et al. Effectiveness of a Hand Hygiene Program at Child Care Centers: A Cluster Randomized Trial. Pediatrics [Internet]. 2018 Nov 1 [cited 2021 Sep 15];142(5):20181245. Available from: https://pediatrics.aappublications.org/content/142/5/e20181245 Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane database Syst Rev [Internet]. 2020 Nov 20 [cited 2022 Apr 27];11(11). Available from: https://pubmed.ncbi.nlm.nih.gov/33215698/ Ledwaba SE, Becker P, Traore-Hoffman A, Potgieter N. Bacterial Contamination of Children’s Toys in Rural Day Care Centres and Households in South Africa. Int J Environ Res Public Health [Internet]. 2019 Aug 2 [cited 2022 Mar 30];16(16). Available from: /pmc/articles/PMC6720433/ Atekoja OE, Kio JO, Ogundare TT, Ajiboye RO. Availability of Infection Prevention Measures and Occurrence of Infections in Childcare Centres in Sagamu Local Government Area, Ogun State, Nigeria. Ann Heal Res. 2023;9(2):146–57. Munoz-Figueroa GP, Ojo O. The effectiveness of alcohol-based gel for hand sanitising in infection control. Br J Nurs [Internet]. 2018 Apr 12 [cited 2022 Apr 27];27(7):382–8. Available from: https://pubmed.ncbi.nlm.nih.gov/29634339/ WHO. Children: improving survival and well-being [Internet]. News room. 2021 [cited 2021 Jul 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality Atekoja O., Kio J, Maitanmi J. Infection prevention practice among caregivers and the effect on occurrence of infection in child care centers in Ogun state Nigeria. 2023;16(2):157–66. Oduntan F. Assessment of quality standard in daycare centers and pre-school in South-West, Nigeria. Exig Issues Educ. 2018 Sep 3;9(3). The ADAPTE Collaboration. The ADAPTE Process: Resource Toolkit for Guideline Adaptation. Guideline International Network; 2009. 1–95 p. Health Protection Scotland. Infection Prevention and Control in Childcare Settings (Day Care and Childminding Settings). 2018. Minstry of Health Singapore. Infection Prevention GUidelines for schools (Primary) and childcare centers. In: Third. 2019. Public health Agency Ireland-Northern. Infection prevention and control: Best practice advice for nurseries and childcare settings. Belfast; 2017. 1–32 p. Toronto Public Health HEIP and control in CCC. Infection Prevention and Control in Child Care Centres; Requirements and Best Practices. 2019. 1–50 p. Peel Public Health. Preventing and managing illnesses in childcare centers [Internet]. Ontario: Peel Public Health; Available from: peelregion.ca/health%0D Brouwers M, Kho M, Browman G, Cluzeau F, Feder G, Fervers B, et al. AGREE Next Steps Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. 2010;182:839–42. Atekoja OE, Maitanmi J. Caregiver ’ s knowledge and practice of infection preventive measures in childcare centers in Ogun state Nigeria. Equity J Sci Technol. 2024;11(1):30–7. Alsabri M, Siddiq A, Aderinto N, Ishola I V., Shahid MA, Kaul A, et al. Infectious Disease Management in Pediatric Emergency Departments in Low- and Middle-Income Countries: A Review of Diagnostic Tools, Treatment Protocols, and Preventive Measures. Glob Pediatr Heal [Internet]. 2024 Jan 1 [cited 2025 May 31];11:2333794X241304663. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11663264/ He Z, Bishwajit G, Zou D, Yaya S, Cheng Z, Zhou Y. Burden of Common Childhood Diseases in Relation to Improved Water, Sanitation, and Hygiene (WASH) among Nigerian Children. Int J Environ Res Public Health [Internet]. 2018 Jun 12 [cited 2025 May 31];15(6):1241. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6025597/ Moore G, Campbell M, Copeland L, Craig P, Movsisyan A, Hoddinott P, et al. Adapting interventions to new contexts—the ADAPT guidance. BMJ [Internet]. 2021 Aug 3 [cited 2025 May 31];374:n1679. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8329746/ Escoffery C, Lebow-Skelley E, Udelson H, Böing EA, Wood R, Fernandez ME, et al. A scoping study of frameworks for adapting public health evidence-based interventions. Transl Behav Med. 2019 Jan 1;9(1):1–10. Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, et al. Core components for effective infection prevention and control programmes: New WHO evidence-based recommendations. Antimicrob Resist Infect Control. 2017 Jan 10;6(1). Saravanos GL, Islam MS, Huang Y, Basseal JM, Seale H, Mitchell BG, et al. Infection prevention and control programme priorities for sustainable health and environmental systems. BMC Glob Public Heal 2024 21 [Internet]. 2024 Feb 1 [cited 2025 May 31];2(1):1–4. Available from: https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-023-00031-4 Beauchemin M, Cohn E, Shelton RC. Implementation of clinical practice guidelines in the healthcare setting: A Concept Analysis. ANS Adv Nurs Sci [Internet]. 2019 Oct 1 [cited 2025 May 31];42(4):307. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6717691/ Breneol S, Curran JA, Marten R, Minocha K, Johnson C, Wong H, et al. Strategies to adapt and implement health system guidelines and recommendations: a scoping review. Heal Res Policy Syst [Internet]. 2022 Dec 1 [cited 2025 May 31];20(1):64. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9202131/ Fennelly O, Cunningham C, Grogan L, Cronin H, O’Shea C, Roche M, et al. Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inform [Internet]. 2020 Dec 1 [cited 2025 May 31];144:104281. Available from: https://www.sciencedirect.com/science/article/pii/S1386505620310650 Delgado-hito P, Martínez-estalella G, Via-clavero G. Implementation of the evidence for the improvement of nursing care to the critical patient ’ s family : a Participatory Action. 2018;1–9. Puchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, et al. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol [Internet]. 2016 Aug 1 [cited 2025 May 31];76:229–37. Available from: https://www.sciencedirect.com/science/article/pii/S0895435616001542 Additional Declarations No competing interests reported. Supplementary Files IPCGUIDELINEINCCs.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6968773","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498356406,"identity":"147991e7-c046-4ff7-aff2-8c48947aea63","order_by":0,"name":"Atekoja Oluwabusolami Esther","email":"data:image/png;base64,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","orcid":"","institution":"Olabisi Onabanjo University","correspondingAuthor":true,"prefix":"","firstName":"Atekoja","middleName":"Oluwabusolami","lastName":"Esther","suffix":""}],"badges":[],"createdAt":"2025-06-24 20:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6968773/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6968773/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88754633,"identity":"aed4cc2d-a647-46b8-9d29-936af2c29ab7","added_by":"auto","created_at":"2025-08-11 07:09:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56601,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGuideline Adaptation Development Process. \u003c/strong\u003e[11]\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6968773/v1/cd8d41515e39b855031b0ada.jpeg"},{"id":88754635,"identity":"b0569aa6-53a7-4f6a-8ae8-bccdfb2d9dd0","added_by":"auto","created_at":"2025-08-11 07:09:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22043,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssessment of Guidelines Quality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG1\u003c/strong\u003e= Guideline on infection prevention and control in childcare settings (Scotland)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG2\u003c/strong\u003e= Infection prevention guidelines for schools (primary) and childcare centers (Singapore)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG3\u003c/strong\u003e= Guideline on infection prevention and control. Best practice advice for nurseries and childcare settings (Northern Ireland)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG4\u003c/strong\u003e= Guideline on Preventing and managing illnesses in childcare centers ( Ontario)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG5\u003c/strong\u003e= Guideline on infection and control in childcare centers ( Toronto)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6968773/v1/e6ab9ecf19433c4a6c55dbb6.png"},{"id":100371457,"identity":"58e04293-fdf9-4610-884c-89d8e7eccaa7","added_by":"auto","created_at":"2026-01-16 08:10:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":929670,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6968773/v1/ff676b6f-9d9b-42a7-97e2-796012634619.pdf"},{"id":88754621,"identity":"6a061c67-5a22-4b1c-97b6-0b50e3ff60b5","added_by":"auto","created_at":"2025-08-11 07:08:55","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":4058265,"visible":true,"origin":"","legend":"","description":"","filename":"IPCGUIDELINEINCCs.docx","url":"https://assets-eu.researchsquare.com/files/rs-6968773/v1/525fee40db5fa21a3fb3b20c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of a Guideline for Infection Prevention and Control in Childcare Centers in Nigeria using the ADAPTE Process","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfectious diseases are a leading cause of morbidity and mortality among children under five, especially in low- and middle-income countries like Nigeria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Childcare centers, vital for early development, often become hotspots for disease spread due to overcrowding, poor sanitation, and hygiene issues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The rising demand for early childcare in Nigeria has led to many centers operating without standardized infection prevention and control (IPC) measures, increasing outbreak risks.\u003c/p\u003e\u003cp\u003eResearch shows that children in childcare are more vulnerable to infections—such as diarrheal and respiratory illnesses—than those cared for at home [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This problem is not only a Nigerian but a global public health concern. Despite expanding childcare services, Nigeria lacks IPC guidelines suited to these settings. Many centers operate without trained staff, proper hygiene protocols, or regulatory oversight, leading to higher infection rates and preventable child illnesses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Evidence suggests that the absence of comprehensive IPC measures is associated with a higher disease burden among children in these environments [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, existing IPC guidelines, when available, are often too complicated, poorly enforced, or not adapted to local needs, resulting in low adherence and limited impact [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This situation worsens health risks, increases absenteeism, adds healthcare costs for families, and may cause long-term developmental issues in children. Developing practical, context-specific IPC guidelines is crucial to reducing these risks and improving health outcomes in Nigerian childcare settings [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe ADAPTE framework provides a systematic, participatory, and evidence-based method for customizing existing guidelines to local conditions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It involves three phases—set-up, adaptation, and finalization—ensuring methodological rigor and cultural relevance while engaging stakeholders. This approach offers a practical way to adapt global best practices for the Nigerian context.\u003c/p\u003e\u003cp\u003eThis study describes the development of an IPC guideline for childcare centers in Ogun State, Nigeria, using the ADAPTE framework. The goal is to create an actionable, evidence-based, and locally relevant guideline that improves infection control, protects child health, and supports sustainable public health efforts in early childhood education settings.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003eThis methodological study described the process of screening and adapting pre-existing guidelines for antipsychotic-induced hyperprolactinemia according to the ADAPTE process. The overall objective of adaptation is to take advantage of existing guidelines in order to enhance the efficient production and use of high-quality adapted guidelines. The adaptation process is meant to ensure that the final recommendations address specific health questions relevant to the context of use and address the needs, priorities, legislation, policies, and resources in the target setting, without undermining the validity of the resulting recommendations. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] The ADAPTE process is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThis study was conducted under the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Babcock University Health Research Ethics Committee (BUHREC), with reference number NHREC/24/01/2020. Approval was obtained from the Ogun State Ministry of Education, Science, and Technology, and the State Universal Basic Education Board. The requirement for informed consent was waived by the Babcock University Health Research Ethics Committee (BUHREC), as the study involved the analysis of publicly available or anonymized data. This waiver complies with national ethical regulations.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePhases for adapting a guideline\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThree phases are needed to ensure guideline adaptation from one setting to another. The steps include the set-up phase, the adaptation phase, and the final phase. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eSet-up Phase: activities in this phase include outlining the necessary tasks to be completed before beginning the adaptation process (e.g., identifying necessary skills and resources), with a first step of determining whether adaptation is feasible. It is expected that the guideline developer check whether adaptation is feasible, even if there are existing guidelines for a specific topic. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eAdaptation Phase: This initial stage involves defining the topic, formulating relevant health questions, retrieving guidelines, evaluating evidence consistency and guideline quality, and preparing a draft adapted guideline. After identifying a broad topic, it’s important to clarify the purpose and scope by developing structured key questions. Clear health questions are vital for completing the adaptation process and ensuring the final guideline’s relevance in the new context. The framework considers key elements such as the target population, recommended actions, involved personnel, expected outcomes, and the delivery setting. It helps define health questions covering all relevant aspects: the population and disease characteristics, intervention(s), targeted professionals, anticipated outcomes, including patient and system results, and the healthcare setting for guideline implementation. Existing guidelines can assist in formulating health questions, and a quick review of their content may reveal additional questions. A search strategy should be developed based on the key questions to find guidelines and relevant documents, with inclusion and exclusion criteria set early based on factors like year, language, and developer group. Extensive searches are necessary to find suitable guidelines for adaptation, though sometimes prioritizing the adaptation of a specific guideline may be more effective than searching multiple sources. Screening retrieved guidelines aims to select those for further assessment, including a preliminary review of health questions to discard irrelevant guidelines. After screening, a draft adapted guideline is created, finalized once the developer determines the content and documents the process used. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eFinal Phase: this phase guides the user through the process of obtaining feedback on the document from stakeholders who will be impacted by the guideline, consulting with the source developers of guidelines used in the adaptation process, establishing a process for the review, and updating of the adapted guideline, and creating a final document. Furthermore, the following is expected to be done. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eExternal review - Once the panel has decided to adapt the guideline, the next step is to send it to those affected by its implementation. This includes users such as practitioners, patients, policy makers, decision makers, organization representatives, and managers. Different questions may be posed to each group. The feedback should evaluate user acceptance, strengths, limitations, and areas needing refinement, as well as gauge confidence in the adaptation process and the likelihood of using the guideline. It should also consider the guideline's impact on current practices and resources. Additionally, endorsement bodies, such as professional or regulatory organizations closely linked to the guideline topic, should be approached to obtain formal approval to facilitate broad application. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSet-Up Phase\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe activities in this phase include outlining the necessary tasks to be completed prior to beginning the adaptation process (e.g., identifying necessary skills and resources), with a first step of determining whether adaptation is feasible. The guideline developers check whether the adaptation and select a specific topic.\u003c/p\u003e\u003cp\u003eThe title Infection Prevention and Control of Infection in Childcare Centers was selected as a topic. The main reason for the choice of this topic was a lack of guidelines to address infection prevention in Childcare centers and the increasing challenges of infection occurrence among children attending Childcare centers. The protocol for developing the guideline was understood. The resources and skills needed for the adaptation process were identified, which include guidelines to be adopted, research assistants, how to involve the stakeholders etc.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdaptation Phase\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis phase begins with topic selection and the identification of specific health questions. It involves searching for and retrieving guidelines, assessing the quality, consistency, currency, content, and applicability of the evidence, making decisions about adaptation, and preparing the draft of the adapted guideline.\u003c/p\u003e\u003cp\u003e\u003cb\u003eScope and Purpose\u003c/b\u003e \u0026ndash; Determining the health question using the PIPOH instrument. The researcher defined the PIPOH tool to help define the health questions.\u003c/p\u003e\u003cp\u003ePopulation: are caregivers who take care of children in the childcare center, the caregiver must be above 18 years old, and could be male or female. The ownership of the Childcare Centers is not a barrier to the usage of the guideline, meaning the guideline applies to both public and private Childcare centers.\u003c/p\u003e\u003cp\u003eIntervention: This is limited to the practice of the guideline to prevent infection among the children in the childcare center.\u003c/p\u003e\u003cp\u003eProfessionals: since the caregivers have the primary responsibility of caring for the children while in the Childcare centers, they become the professionals in this guideline. If the Childcare center is owned by a school, then teachers become the professionals, but if it is a standalone Childcare center, then the caregiver who is the service provider becomes the professional.\u003c/p\u003e\u003cp\u003eOutcomes and outcome measures: Ideally, the guideline will encourage caregivers to understand they have a role to play in reducing the occurrence of infection in children. Likewise, it will help to promote the health of the children and at the same time reduce the morbidity rate among children, as this is an issue of public health importance.\u003c/p\u003e\u003cp\u003eHealthcare setting and context: The guideline applies to childcare centers either in schools or within the community.\u003c/p\u003e\u003cp\u003eWith the use of the PIPOH, the following health questions were raised as stated on Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealth Questions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are infections, and the causes?\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow does infection spread?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are the roles of caregivers in hand hygiene for infection prevention?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are the roles of caregivers in nasal hygiene?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow is personal protective equipment used in the Childcare centers?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are the steps to cleaning and disinfecting the environment of the childcare centers?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow should food be handled by the caregiver?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow should waste be managed in the Childcare centers?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmunization of the children and caregivers, how important is it?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat should be done when a child is sick in the Childcare centers?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSearch for guidelines and other relevant documents\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBased on the key questions defined in the scope and purpose, a search strategy was developed internet search engines such as Google, Medline, ProQuest, were searched for the word \u0026lsquo;Guideline for infection prevention in Childcare center\u0026rsquo;, \u0026lsquo;Infection prevention for day-care,\u0026rsquo; \u0026lsquo;Guideline for infection control in creche\u0026rsquo;, the search was limited to year 2000 to 2023. Guidelines were limited to those written in the English language. A single author guideline was not included in the search; below is the summary of the result. The guideline search found eight infection prevention guidelines for childcare centers from other countries (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eSearch for guidelines and other relevant documents\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublisher\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePublication date\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement of Infectious diseases in Childcare Facilities and other Childcare settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth Protection Surveillance center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection prevention and control in childcare settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth Protection Scotland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScotland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection Prevention guidelines for schools (primary) and childcare centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMinistry of health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingapore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection prevention and control. Best practice advice for nurseries and childcare settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Health Agency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNorthern Ireland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreventing and managing illnesses in childcare centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeel Public Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOntario\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en.d\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection prevention and control in childcare centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eToronto public Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eToronto\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard and Universal Precautions in the Child Care Setting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildcare Health program\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCalifornia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection control guidelines for early learning and childcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy Child Manitoba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eManitoba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en.d\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssessment of guideline quality\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUpon review of the eight guidelines, five were identified to be more detailed and useful for the adaptation process. The five selected guidelines were assessed for quality, currency, content, consistency, and acceptability/ applicability. [\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The evaluation of these different aspects provided the basis for making an informed and transparent decision about whether the source guidelines are related and for identifying which recommendations can be adapted into the current guideline.\u003c/p\u003e\u003cp\u003eTo assess the quality of the guidelines, the appraisal of guideline research and evaluation (AGREE II) instrument was used, which contains a 23-item tool comprising 6 quality domains. Domain 1. Scope and Purpose, Domain 2. Stakeholder, Domain 3. Rigour of Development, Domain 4. Clarity of Presentation, Domain 5. Applicability, Domain 6. Editorial Independence. Overall assessment includes the rating of the overall quality of the guideline and whether the guideline would be recommended for use in practice as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe appraisal gives an in-depth understanding of the content of each identified guideline, also gives a better awareness of the guidelines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssessment of currency\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe publication dates of each of the identified guidelines were assessed. The five guidelines were identified to be up to date. Some of the guidelines were recently revised and other newly developed as dated on the Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCurrency of the Adapted Guidelines\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS/N\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePublisher\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublication date\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection prevention and control in childcare settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHealth Protection Scotland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eScotland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection Prevention guidelines for schools (primary) and childcare centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMinistry of health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSingapore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection prevention and control. Best practice advice for nurseries and childcare settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePublic Health Agency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNorthern Ireland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreventing and managing illnesses in childcare centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePeel Public Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOntario\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en.d\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection prevention and control in childcare centers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eToronto public Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eToronto\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssessment for acceptability and applicability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe acceptability and applicability of a guideline's recommendations for a new guideline depend on the degree to which a guideline will need adaptation based on the cultural and organizational diversity. It was discovered that the listed guidelines described the population eligible to use the guideline. The interventions listed in the guidelines met the current situation and are applicable, although some contents are not applicable in the cultural setting of Nigeria as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The guidelines were able to answer the health questions stated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIllustrating the Applicability of the Guidelines.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eG3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eG4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eG5\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are infections, and the causes?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow does infection spread?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are the roles of caregivers in hand hygiene for infection prevention?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are the roles of caregivers in nasal hygiene?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow is personal protective equipment used in the Childcare centers?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are the steps to cleaning and disinfecting the environment of the childcare centers?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow should food be handled by the caregiver?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow should waste be managed in the Childcare centers?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmunization of the children and caregivers, how important is it?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat should be done when a child is sick in the Childcare centers?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat are infections, and the causes?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow does infection spread?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e✓\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eKey: G1\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Guideline on infection prevention and control in childcare settings (Scotland)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eG2\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Infection prevention guidelines for schools (primary) and childcare centers\u003c/p\u003e\u003cp\u003e(Singapore)\u003c/p\u003e\u003cp\u003e\u003cb\u003eG3\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Guideline on infection prevention and control. Best practice advice for nurseries\u003c/p\u003e\u003cp\u003eand childcare settings (Northern Ireland)\u003c/p\u003e\u003cp\u003e\u003cb\u003eG4\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Guideline on Preventing and managing illnesses in childcare centers ( Ontario)\u003c/p\u003e\u003cp\u003e\u003cb\u003eG5\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Guideline on infection and control in childcare centers (Toronto)\u003c/p\u003e\u003cp\u003e\u003cb\u003ePreparation of the draft adapted guideline\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe guideline was developed based on the health questions raised. The drafted guideline was sectioned into four chapters. The five identified guidelines were used to develop the guideline, which covered all aspects of the health questions raised. The cultural applicability of the guideline was considered bearing in mind that none of the identified guidelines originated in Africa country.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFinal Phase\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe final phase guides through the process of obtaining feedback on the document from stakeholders impacted by the guideline. This process is called the external review. The draft guideline for infection prevention and control in the childcare center was sent to experts in the field of infection prevention, paediatricians, and teachers. The external reviews were asked to provide their input on the guideline. The external reviewers made a few comments. The final version of the adapted guideline was formatted to take into consideration the external reviewers\u0026rsquo; comments (Supplementary material).\u003c/p\u003e\u003cp\u003e\u003cb\u003eValidation of The Guideline Using Appraisal of Guidelines for Research \u0026amp; Evaluation II Instrument\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe appraisal of guidelines for research \u0026amp; evaluation II (AGREE II) tool is designed not only to give individual scores to each of the 23 statements, (17) but also to provide an overall domain score for each of the six domains that averages all of the appraiser responses.\u003c/p\u003e\u003cp\u003eThe guideline was validated by four experts, two in the education sector (the representative of the Ministry of Education, Science and Technology and Ogun State Universal Basic Education Board) and two experts in the health sector (Public Health Nurse and Paediatrician). The evaluation was done using the AGREE II Instrument. To assess guideline quality, the AGREE II framework offers structured criteria across multiple evaluation domains. of the practice guideline and consists of 23 items organized into six domains.\u003c/p\u003e\u003cp\u003eDomain 1 addressed the scope and purpose of the guideline through three key questions that concentrated on the aim, health questions, and target population. All appraisers scored each item within this domain at an average score of 94%.\u003c/p\u003e\u003cp\u003eDomain 2 assessed the stakeholders\u0026rsquo; involvement through three questions that focused on guideline development. The average score for this domain was 94%.\u003c/p\u003e\u003cp\u003eDomain 3 addressed the rigor and development of the guideline; this section contained eight items and focused on the method of gathering and analysing evidence. The appraisers\u0026rsquo; average score for this domain was 85%.\u003c/p\u003e\u003cp\u003eDomain 4 included three key items that evaluated clarity and presentation of the All appraisers scored this section with an average score of 95%.\u003c/p\u003e\u003cp\u003eDomain 5 addressed the applicability of the guideline through four questions. One of the questions in this domain, Item 21 (the guideline present monitoring and/or auditing criteria) did not apply, and adjustments were made to the adjusted score for Domain 5 was 93%. The item with the lowest scores in this domain was Item 18, which addressed the guideline description of facilitators and barriers.\u003c/p\u003e\u003cp\u003eDomain 6 validated two items for the editorial independence, the combined score for Domain 6 reported score was 90%.\u003c/p\u003e\u003cp\u003eThe last two items in the AGREE II instrument were included in the section titled \u0026ldquo;overall guideline assessment\u0026rdquo;. The first item in this section required appraisers to rate the overall quality of the guideline, and the combined score for this section was 88%. The second item required participants to respond to the statement, \u0026ldquo;I would recommend this guideline for use.\u0026rdquo; The responses included yes, yes with medication, or no. Two of the appraisers reported yes for this section, and two reported yes with modifications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe development of an infection prevention and control (IPC) guideline for childcare centers in Nigeria using the ADAPTE framework highlights a strategic effort to close a critical public health gap. In Nigeria and other low-resource settings, children in institutional care environments face elevated risks of infectious diseases due to poor hygiene, limited caregiver training, and inadequate infrastructure. [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] These vulnerabilities are exacerbated by the absence of standardized, context-specific IPC protocols, underscoring the need for a structured and locally adapted guideline.\u003c/p\u003e\u003cp\u003eThis study demonstrated the utility of the ADAPTE methodology in translating global best practices into practical and culturally aligned solutions. The process enabled the selection, critical appraisal, and contextual modification of five internationally developed IPC guidelines. According to recent literature, adapting existing guidelines, rather than creating new ones from scratch, enhances cost-effectiveness, shortens development timelines, and improves the contextual relevance of interventions. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eBy using the PIPOH framework, the health questions formulated addressed core concerns such as hand hygiene, personal protective equipment use, environmental disinfection, food handling, and the management of ill children\u0026mdash;all areas closely linked to infection transmission in childcare settings. These align with the growing global emphasis on environmental and behavioural components of IPC, particularly in congregate childcare environments. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eStakeholder engagement, through external reviews by health and education professionals, was a cornerstone of the adaptation process. Their input strengthened the guideline's relevance, usability, and acceptability. Recent implementation research emphasizes that the involvement of end-users during the design phase of health guidelines is a predictor of successful adoption and sustained use. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe AGREE II validation scores further affirm the quality of the adapted guideline. High ratings in domains such as \u0026ldquo;scope and purpose,\u0026rdquo; \u0026ldquo;stakeholder involvement,\u0026rdquo; and \u0026ldquo;clarity of presentation\u0026rdquo; mirror findings from recent studies on best practices in guideline adaptation. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] This reflects not only the methodological robustness of the guideline but also its potential to influence caregiver behaviour and policy formulation in Nigeria.\u003c/p\u003e\u003cp\u003eHowever, as with most guideline development projects, implementation remains a potential challenge. Evidence from similar LMIC contexts shows that without ongoing training, supervision, and institutional support, the translation of guidelines into practice is often limited. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Thus, to ensure sustainability, this guideline must be integrated into existing health and education frameworks and supported by capacity-building programs for caregivers.\u003c/p\u003e\u003cp\u003eIn summary, the adaptation of IPC guidelines for childcare centers using the ADAPTE process provides a replicable model for other low-resource settings facing similar challenges. The project fills a critical gap in Nigeria\u0026rsquo;s childcare health landscape and represents a meaningful step toward reducing infection rates and promoting child health through locally appropriate, evidence-based interventions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study successfully developed a context-specific guideline for infection prevention and control (IPC) in Nigerian childcare centers using the ADAPTE framework. By systematically adapting high-quality international guidelines and tailoring them to the local cultural, infrastructural, and regulatory realities, the resulting guideline offers a practical tool for reducing the burden of infectious diseases among children in early childcare settings. The involvement of key stakeholders and the use of a validated appraisal tool (AGREE II) ensured methodological rigor, stakeholder relevance, and clarity of presentation. The guideline addresses critical areas of IPC, including hand hygiene, environmental cleaning, food safety, waste management, and the management of sick children, thereby equipping caregivers with actionable steps to prevent disease transmission. Its development represents a significant step toward strengthening childcare health systems in Nigeria and contributes to the global agenda of reducing under-five morbidity from preventable infections.\u003c/p\u003e\u003cp\u003eHowever, the absence of a pilot implementation phase highlights the need for future research to evaluate the guideline\u0026rsquo;s real-world effectiveness and scalability. To ensure sustainable impact, efforts must focus on integrating the guideline into existing health and education policies, providing caregiver training, and securing institutional support.\u003c/p\u003e\u003cp\u003eIn conclusion, this adapted IPC guideline is a critical and timely response to the infection control challenges in Nigerian childcare centers. If effectively implemented, it holds the potential to improve child health outcomes, enhance caregiver practices, and support broader public health objectives in Nigeria and similar low-resource settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths of the Study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study applied the internationally recognized ADAPTE framework, ensuring a structured, evidence-informed, and transparent adaptation of global IPC guidelines to the Nigerian context. This enhances the credibility and methodological rigor of the guideline development. The adapted guideline addresses specific local needs by incorporating Nigeria-specific cultural, infrastructural, and policy-related realities, increasing its feasibility and applicability in childcare settings. Input from both healthcare and education sector experts, including public health professionals, paediatricians, and education administrators, ensured a broad-based consensus and relevance across disciplines. The quality of the adapted guideline was thoroughly evaluated using the AGREE II instrument, providing a robust assessment of its scope, rigor, clarity, and stakeholder involvement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations of the Study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLack of African-Origin Guidelines for Benchmarking; all source guidelines used for adaptation were from non-African, high-income countries, which may limit the relevance of certain content despite contextual modifications. Although the guideline is tailored to low-resource settings, its successful implementation may still face challenges such as inadequate training, limited funding, and insufficient monitoring infrastructure in many Nigerian childcare centers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCCs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Childcare Centers\u003c/p\u003e\n\u003cp\u003eIPC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Infection Prevention and Control\u003c/p\u003e\n\u003cp\u003eADAPTE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Adaptation (a systematic framework for guideline adaptation, from the ADAPTE Collaboration)\u003c/p\u003e\n\u003cp\u003ePIPOH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Population, Intervention, Professionals, Outcome, Health system\u003c/p\u003e\n\u003cp\u003eAGREE II\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Appraisal of Guidelines for Research and Evaluation II\u003c/p\u003e\n\u003cp\u003eWHO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e\n\u003cp\u003eBUHREC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Babcock University Health Research Ethics Committee\u003c/p\u003e\n\u003cp\u003eG1\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Guideline on infection prevention and control in childcare settings (Scotland)\u003c/p\u003e\n\u003cp\u003eG2\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Infection prevention guidelines for schools (primary) and childcare centers (Singapore)\u003c/p\u003e\n\u003cp\u003eG3\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Guideline on infection prevention and control: Best practice advice for nurseries and childcare settings (Northern Ireland)\u003c/p\u003e\n\u003cp\u003eG4\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Guideline on Preventing and managing illnesses in childcare centers (Ontario)\u003c/p\u003e\n\u003cp\u003eG5\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Guideline on infection and control in childcare centers (Toronto)\u003c/p\u003e\n\u003cp\u003eLMIC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eCOVID-19\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003ePMCID \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;PubMed Central Identifier (used in citations, e.g., PMC articles)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Babcock University Health Research Ethics Committee (BUHREC) with approval number NHREC/24/01/2020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e All data and materials in this article are included in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The author did not received any funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e \u0026ndash; OE: Conceptualization, data collection and analysis, manuscript draft and final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAppreciation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author appreciates the Babcock University Health Research Ethics Committee (BUHREC) for providing ethical approval and guidance, as well as to the Ogun State Ministry of Education, Science and Technology, and the Ogun State Universal Basic Education Board for granting institutional support and access to key stakeholders. Likewise, all the external reviewers\u0026mdash;including public health professionals, paediatricians, education officers, and caregivers\u0026mdash;who generously contributed their expertise and constructive feedback during the adaptation of the guideline. Lastly, the author appreciates all research assistants, collaborators, and caregivers in the participating childcare centers, whose cooperation and participation made this work possible.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. Infection prevention and control in the context of coronavirus disease (\u0026lrm;COVID-19)\u0026lrm;: a living guideline [Internet]. Health Topics. 2023 [cited 2025 May 28]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-guideline-2023.2\u003c/li\u003e\n\u003cli\u003eAzor-Martinez E, Garcia-Fernandez L, Strizzi JM, Cantarero-Vallejo MD, Jimenez-Lorente CP, Balaguer-Martinez JV, et al. Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial. Am J Infect Control. 2020 Nov 1;48(11):1315\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eAzor-Martinez E, Yui-Hifume R, Mu\u0026ntilde;oz-Vico FJ, Jimenez-Noguera E, Strizzi JM, Martinez-Martinez I, et al. Effectiveness of a Hand Hygiene Program at Child Care Centers: A Cluster Randomized Trial. Pediatrics [Internet]. 2018 Nov 1 [cited 2021 Sep 15];142(5):20181245. Available from: https://pediatrics.aappublications.org/content/142/5/e20181245\u003c/li\u003e\n\u003cli\u003eJefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane database Syst Rev [Internet]. 2020 Nov 20 [cited 2022 Apr 27];11(11). Available from: https://pubmed.ncbi.nlm.nih.gov/33215698/\u003c/li\u003e\n\u003cli\u003eLedwaba SE, Becker P, Traore-Hoffman A, Potgieter N. Bacterial Contamination of Children\u0026rsquo;s Toys in Rural Day Care Centres and Households in South Africa. Int J Environ Res Public Health [Internet]. 2019 Aug 2 [cited 2022 Mar 30];16(16). Available from: /pmc/articles/PMC6720433/\u003c/li\u003e\n\u003cli\u003eAtekoja OE, Kio JO, Ogundare TT, Ajiboye RO. Availability of Infection Prevention Measures and Occurrence of Infections in Childcare Centres in Sagamu Local Government Area, Ogun State, Nigeria. Ann Heal Res. 2023;9(2):146\u0026ndash;57. \u003c/li\u003e\n\u003cli\u003eMunoz-Figueroa GP, Ojo O. The effectiveness of alcohol-based gel for hand sanitising in infection control. Br J Nurs [Internet]. 2018 Apr 12 [cited 2022 Apr 27];27(7):382\u0026ndash;8. Available from: https://pubmed.ncbi.nlm.nih.gov/29634339/\u003c/li\u003e\n\u003cli\u003eWHO. Children: improving survival and well-being [Internet]. News room. 2021 [cited 2021 Jul 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality\u003c/li\u003e\n\u003cli\u003eAtekoja O., Kio J, Maitanmi J. Infection prevention practice among caregivers and the effect on occurrence of infection in child care centers in Ogun state Nigeria. 2023;16(2):157\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eOduntan F. Assessment of quality standard in daycare centers and pre-school in South-West, Nigeria. Exig Issues Educ. 2018 Sep 3;9(3). \u003c/li\u003e\n\u003cli\u003eThe ADAPTE Collaboration. The ADAPTE Process: Resource Toolkit for Guideline Adaptation. Guideline International Network; 2009. 1\u0026ndash;95 p. \u003c/li\u003e\n\u003cli\u003eHealth Protection Scotland. Infection Prevention and Control in Childcare Settings (Day Care and Childminding Settings). 2018. \u003c/li\u003e\n\u003cli\u003eMinstry of Health Singapore. Infection Prevention GUidelines for schools (Primary) and childcare centers. In: Third. 2019. \u003c/li\u003e\n\u003cli\u003ePublic health Agency Ireland-Northern. Infection prevention and control: Best practice advice for nurseries and childcare settings. Belfast; 2017. 1\u0026ndash;32 p. \u003c/li\u003e\n\u003cli\u003eToronto Public Health HEIP and control in CCC. Infection Prevention and Control in Child Care Centres; Requirements and Best Practices. 2019. 1\u0026ndash;50 p. \u003c/li\u003e\n\u003cli\u003ePeel Public Health. Preventing and managing illnesses in childcare centers [Internet]. Ontario: Peel Public Health; Available from: peelregion.ca/health%0D\u003c/li\u003e\n\u003cli\u003eBrouwers M, Kho M, Browman G, Cluzeau F, Feder G, Fervers B, et al. AGREE Next Steps Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. 2010;182:839\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eAtekoja OE, Maitanmi J. Caregiver \u0026rsquo; s knowledge and practice of infection preventive measures in childcare centers in Ogun state Nigeria. Equity J Sci Technol. 2024;11(1):30\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eAlsabri M, Siddiq A, Aderinto N, Ishola I V., Shahid MA, Kaul A, et al. Infectious Disease Management in Pediatric Emergency Departments in Low- and Middle-Income Countries: A Review of Diagnostic Tools, Treatment Protocols, and Preventive Measures. Glob Pediatr Heal [Internet]. 2024 Jan 1 [cited 2025 May 31];11:2333794X241304663. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11663264/\u003c/li\u003e\n\u003cli\u003eHe Z, Bishwajit G, Zou D, Yaya S, Cheng Z, Zhou Y. Burden of Common Childhood Diseases in Relation to Improved Water, Sanitation, and Hygiene (WASH) among Nigerian Children. Int J Environ Res Public Health [Internet]. 2018 Jun 12 [cited 2025 May 31];15(6):1241. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6025597/\u003c/li\u003e\n\u003cli\u003eMoore G, Campbell M, Copeland L, Craig P, Movsisyan A, Hoddinott P, et al. Adapting interventions to new contexts\u0026mdash;the ADAPT guidance. BMJ [Internet]. 2021 Aug 3 [cited 2025 May 31];374:n1679. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8329746/\u003c/li\u003e\n\u003cli\u003eEscoffery C, Lebow-Skelley E, Udelson H, B\u0026ouml;ing EA, Wood R, Fernandez ME, et al. A scoping study of frameworks for adapting public health evidence-based interventions. Transl Behav Med. 2019 Jan 1;9(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eStorr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, et al. Core components for effective infection prevention and control programmes: New WHO evidence-based recommendations. Antimicrob Resist Infect Control. 2017 Jan 10;6(1). \u003c/li\u003e\n\u003cli\u003eSaravanos GL, Islam MS, Huang Y, Basseal JM, Seale H, Mitchell BG, et al. Infection prevention and control programme priorities for sustainable health and environmental systems. BMC Glob Public Heal 2024 21 [Internet]. 2024 Feb 1 [cited 2025 May 31];2(1):1\u0026ndash;4. Available from: https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-023-00031-4\u003c/li\u003e\n\u003cli\u003eBeauchemin M, Cohn E, Shelton RC. Implementation of clinical practice guidelines in the healthcare setting: A Concept Analysis. ANS Adv Nurs Sci [Internet]. 2019 Oct 1 [cited 2025 May 31];42(4):307. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6717691/\u003c/li\u003e\n\u003cli\u003eBreneol S, Curran JA, Marten R, Minocha K, Johnson C, Wong H, et al. Strategies to adapt and implement health system guidelines and recommendations: a scoping review. Heal Res Policy Syst [Internet]. 2022 Dec 1 [cited 2025 May 31];20(1):64. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9202131/\u003c/li\u003e\n\u003cli\u003eFennelly O, Cunningham C, Grogan L, Cronin H, O\u0026rsquo;Shea C, Roche M, et al. Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inform [Internet]. 2020 Dec 1 [cited 2025 May 31];144:104281. Available from: https://www.sciencedirect.com/science/article/pii/S1386505620310650\u003c/li\u003e\n\u003cli\u003eDelgado-hito P, Mart\u0026iacute;nez-estalella G, Via-clavero G. Implementation of the evidence for the improvement of nursing care to the critical patient \u0026rsquo; s family : a Participatory Action. 2018;1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003ePuchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, et al. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol [Internet]. 2016 Aug 1 [cited 2025 May 31];76:229\u0026ndash;37. Available from: https://www.sciencedirect.com/science/article/pii/S0895435616001542\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Infection prevention, Childcare centers, Guideline adaptation, ADAPTE process, Nigeria, Infection control, Public health","lastPublishedDoi":"10.21203/rs.3.rs-6968773/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6968773/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInfectious diseases remain a leading cause of morbidity and mortality among children under five, especially in low- and middle-income countries like Nigeria. Childcare centers present high-risk environments for the transmission of infections due to poor hygiene practices, overcrowding, and lack of standardized infection prevention and control (IPC) guidelines. This study aimed to develop a contextually relevant IPC guideline for Nigerian childcare centers using the ADAPTE framework.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA methodological approach was adopted, employing the ADAPTE process, which consists of three phases: set-up, adaptation, and finalization. The PIPOH framework guided the formulation of health questions relevant to infection control in childcare settings. Eight international IPC guidelines were identified through systematic searches of academic and grey literature, out of which five were selected based on quality and applicability. The AGREE II instrument was used to appraise these guidelines. Stakeholders including public health professionals, paediatricians, education officers, and caregivers contributed to the external review of the adapted guideline.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe adapted guideline addresses ten core IPC domains including hand hygiene, nasal hygiene, environmental cleaning, personal protective equipment use, food handling, waste management, immunization, and care of sick children. The final guideline was organized into four chapters and validated using the AGREE II tool. High domain scores (above 85%) were achieved in scope and purpose, stakeholder involvement, clarity, and applicability. The external reviewers confirmed the guideline's relevance and recommended it for implementation with minor modifications.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study successfully adapted a practical, evidence-based IPC guideline suited to the Nigerian childcare context. The guideline has the potential to improve infection prevention practices, reduce childhood morbidity, and enhance caregiver competency. Future research should focus on implementation, training, and outcome evaluation across diverse Nigerian regions to ensure scalability and sustainability.\u003c/p\u003e","manuscriptTitle":"Development of a Guideline for Infection Prevention and Control in Childcare Centers in Nigeria using the ADAPTE Process","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 07:08:35","doi":"10.21203/rs.3.rs-6968773/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40cc4f1f-888e-4c21-96c3-5ccfd439261a","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-14T14:39:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-11 07:08:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6968773","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6968773","identity":"rs-6968773","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}